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Acne Overview

Acne is a very common skin problem that shows up as outbreaks of bumps called pimples or zits. Acne usually appear on the face, neck, back, chest, and shoulders. Acne can be a source of emotional distress, and severe cases can lead to permanent acne scars.

What causes acne?

Acne Lesion Microcomedo

Acne begins when the pores in the skin become clogged and can no longer drain sebum (an oil made by the sebaceous glands that protects and moisturizes the skin.) The sebum build-up causes the surrounding hair follicle to swell.

Hair follicles swollen with sebum are called comedones. If the sebum stays beneath the skin, the comedones produce white bumps called whiteheads. If the sebum reaches the surface of the skin, the comedones produce darkened bumps called blackheads. This black discoloration is due to sebum darkening when it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

Bacteria called Propionibacterium acnes (P. acnes) that normally live on the top of the skin can enter the clogged pores and infect the sebum. This causes the skin to become swollen, red, and painful.

Acne Lesion Blackhead
Acne Lesion Whitehead

Infected sebaceous glands may burst, releasing sebum and bacteria into the surrounding skin, creating additional inflammation. In severe cases, larger nodules and cysts may form in the deeper layers of the skin.

What are the different types of acne?

Acne - severe, cystic acne on forehead
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Acne can be categorized by its severity:
1. Mild acne describes a few scattered comedones (whiteheads or blackheads) with minimal inflammation (no pustules).
2. Moderate acne describes a denser collection of comedones as well as red, inflamed, pus-filled lesions (pustules).
3. Severe acne, also called nodular or cystic acne, describes widespread and deep lesions that are painful, inflamed, and red. This form of acne is likely to lead to scarring if left untreated.

Who gets acne?

Anyone at any age can get acne. Acne in teenagers is very common because the surging hormone levels (androgens) associated with puberty create more active sebaceous glands. Acne in adults is is also very common, especially among women.

Acne is more likely to afflict people whose parents had acne.

What factors make acne worse?

Acne lesions can come and go. These factors can cause acne to worsen:

What acne treatments are available?

Almost all cases of acne can be effectively treated. The goal of acne treatment is to heal existing lesions, stop new lesions from forming, and prevent acne scars.

Different acne medications are available that control one or more of the underlying causes of acne. Common classes of acne medications include the following:

Your doctor will prescribe acne medications based on the following factors:

Non-prescription acne medications may provide sufficient results for some people with mild acne. However, most people with moderate acne and all with severe acne will need to use prescription acne medications for effective treatment.

Whatever your treatment plan, it is important that you give it enough time to work. This may mean waiting 6 to 8 weeks to see results. While the older acne lesions are healing, the medication is hard at work keeping new lesions from forming. Staying on your medication is the most important step to getting acne under control.

How can I keep my acne under control?

After your acne clears, your doctor may recommend that you continue therapy with a topical retinoids to keep it under control. It is always a good idea to maintain good skin care and use skin care products labeled as “non-comedogenic” (do not promote acne)

For ongoing acne skin care and prevention of acne, follow a few simple guidelines: